Abstracts – 2008 - Obstetricia Crítica

Int J Gynaecol Obstet. 2007 Dec;99 Suppl 2:S160-7. Epub 2007 Oct 26.Misoprostol: pharmacokinetic profiles, effects on the uterus and sideeffects.Tang OS, Gemzell-Danielsson K, Ho PC.Department of Obstetrics and Gynaecology, University of Hong Kong, HongKong SAR, China. ostang@graduate.hku.hkMisoprostol, a synthetic prostaglandin E1 analogue, is commonly used formedical abortion, cervical priming, the management of miscarriage, induction oflabor and the management of postpartum hemorrhage. It can be given orally,vaginally, sublingually, buccally or rectally. Studies of misoprostol'spharmacokinetics and effects on uterine activity have demonstrated theproperties of the drug after various routes of administration. These studies canhelp to discover the optimal dose and route of administration of misoprostol forindividual clinical applications. Misoprostol is a safe drug but seriouscomplications and teratogenicity can occur with unsupervised use.Int J Gynaecol Obstet. 2007 Dec;99 Suppl 2:S198-201. Epub 2007 Oct 24.Prevention of postpartum hemorrhage with misoprostol.Alfirevic Z, Blum J, Walraven G, Weeks A, Winikoff B.School of Reproductive and Developmental Medicine, University of Liverpool,Liverpool, UK. zarko@liv.ac.ukAs a stable, orally active and cheap uterotonic, misoprostol would appear ideallysuited to the prevention of postpartum hemorrhage (PPH) in the developingworld. Following numerous clinical trials, it appears that misoprostol prophylaxisusing an oral or sublingual dose of 600 microg is more effective than placebo atpreventing PPH in community births (relative risk 0.59, 95% confidence intervals0.41-0.84), but not in hospital settings (RR 1.23, 95% CI 0.86-1.74). It is,however, not as effective as injectable oxytocin (RR 1.34, 95% CI 1.16 to 1.55).Misoprostol is therefore indicated for prevention of PPH in settings whereinjectable conventional uterotonics are not available. In the event of continuedhemorrhage, a minimum of 2 h should lapse after the original dose before asecond dose is given. If the initial dose was associated with pyrexia or markedshivering, at least 6 h should lapse before the second dose is given.Int J Gynaecol Obstet. 2007 Dec;99 Suppl 2:S190-3. Epub 2007 Oct 24.Misoprostol for intrauterine fetal death.Gómez Ponce de León R, Wing D, Fiala C.Ipas and School of Public Health, UNC at Chapel Hill, Chapel Hill, NC 27510,USA. gomezr@ipas.orgThe frequency of intrauterine fetal death (IUFD) with retained fetus varies, but isestimated to occur in 1% of all pregnancies. The vast majority of women willspontaneously labor and deliver within three weeks of the intrauterine death. Thecomplexity in medical management increases significantly when the cervix isunripe or unfavorable, or when the woman develops disseminated intravascularcoagulation. Misoprostol regimens for the induction of labor for second and thirdtrimester IUFDs, range from 50 to 400 microg every 3 to 12 h, and are all